Healthcare Fraud Analytics Market by Solution Type, Delivery Model, Application, End-User

Description

List of Tables

The Global Healthcare Fraud Analytics Market is forecasted to grow significantly, with a projected USD 6,928.62 million in 2023 at a CAGR of 19.33% and expected to reach a staggering USD 24,271.52 million by 2030.

The Cumulative Impact of COVID-19, the Russia-Ukraine Conflict, and High Inflation is expected to have significant long-term effects on the Global Healthcare Fraud Analytics Market. The ongoing research considers the changes in consumer behavior, supply chain disruptions, and government interventions caused by the pandemic. Similarly, the report considers the ongoing political and economic uncertainty in Eastern Europe caused by the Russia-Ukraine Conflict and its potential implications for demand-supply balances, pressure on pricing variants, and import/export and trading. Additionally, the report addresses the impact of High Inflation on the global economy and details fiscal policies measuring and reducing its effects on demand, supply, cash flow, and currency exchange.

Market Segmentation & Coverage:

This research report categorizes the Global Healthcare Fraud Analytics Market in order to forecast the revenues and analyze trends in each of following sub-markets:

Based on Solution Type, market is studied across Descriptive Analytics, Predictive Analytics, and Prescriptive Analytics. The Descriptive Analytics commanded largest market share of 39.54% in 2022, followed by Prescriptive Analytics.

Based on Delivery Model, market is studied across On-Demand and On-Premise. The On-Demand commanded largest market share of 65.33% in 2022, followed by On-Premise.

Based on Application, market is studied across Insurance Claims Review, Payment Integrity, and Pharmacy Billing Misuse. The Insurance Claims Review is further studied across Post payment Review and Prepayment Review. The Insurance Claims Review commanded largest market share of 32.34% in 2022, followed by Payment Integrity.

Based on End-User, market is studied across Employers, Private Insurance Payers, Public & Government Agencies, and Third-party service providers. The Private Insurance Payers commanded largest market share of 34.12% in 2022, followed by Third-party service providers.

Based on Region, market is studied across Americas, Asia-Pacific, and Europe, Middle East & Africa. The Americas is further studied across Argentina, Brazil, Canada, Mexico, and United States. The United States is further studied across California, Florida, Illinois, New York, Ohio, Pennsylvania, and Texas. The Asia-Pacific is further studied across Australia, China, India, Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam. The Europe, Middle East & Africa is further studied across Denmark, Egypt, Finland, France, Germany, Israel, Italy, Netherlands, Nigeria, Norway, Poland, Qatar, Russia, Saudi Arabia, South Africa, Spain, Sweden, Switzerland, Turkey, United Arab Emirates, and United Kingdom. The Europe, Middle East & Africa commanded largest market share of 39.45% in 2022, followed by Americas.

Market Statistics:

The report provides market sizing and forecasts across 7 major currencies - USD, EUR, JPY, GBP, AUD, CAD, and CHF; multiple currency support helps organization leaders to make well-informed decisions. In this report, 2018 to 2021 are considered as historical years, 2022 is base year, 2023 is estimated year, and years from 2024 to 2030 are considered as forecast period.

FPNV Positioning Matrix:

The FPNV Positioning Matrix is essential for assessing the Global Healthcare Fraud Analytics Market. It provides a comprehensive evaluation of vendors by examining key metrics within Business Strategy and Product Satisfaction, allowing users to make informed decisions based on their specific needs. This advanced analysis then organizes these vendors into four distinct quadrants, which represent varying levels of success: Forefront (F), Pathfinder (P), Niche (N), or Vital(V).

Market Share Analysis:

The Market Share Analysis offers an insightful look at the current state of vendors in a particular market space. By comparing vendor contributions to overall revenue, customer base, and other key metrics, we can give companies a greater understanding of their performance and what they are up against when competing for market share. The analysis also sheds light on just how competitive any given sector is about accumulation, fragmentation dominance, and amalgamation traits over the base year period studied.

The report provides insights on the following pointers:

1. Market Penetration: Provides comprehensive information on the market offered by the key players

2. Market Development: Provides in-depth information about lucrative emerging markets and analyzes penetration across mature segments of the markets

3. Market Diversification: Provides detailed information about new product launches, untapped geographies, recent developments, and investments

4. Market Trends: Provides comprehensive understanding of the Cumulative Impact of COVID-19, the Russia-Ukraine Conflict, and the High Inflation

5. Competitive Assessment & Intelligence: Provides an exhaustive assessment of market shares, strategies, products, certification, regulatory approvals, patent landscape, and manufacturing capabilities of the leading players

6. Product Development & Innovation: Provides intelligent insights on future technologies, R&D activities, and breakthrough product developments

The report answers questions such as:

1. What is the market size and forecast of the Global Healthcare Fraud Analytics Market?

2. What are the inhibiting factors and impact of COVID-19 shaping the Global Healthcare Fraud Analytics Market during the forecast period?

3. Which are the products/segments/applications/areas to invest in over the forecast period in the Global Healthcare Fraud Analytics Market?

4. What is the competitive strategic window for opportunities in the Global Healthcare Fraud Analytics Market?

5. What are the technology trends and regulatory frameworks in the Global Healthcare Fraud Analytics Market?

6. What is the market share of the leading vendors in the Global Healthcare Fraud Analytics Market?

7. What modes and strategic moves are considered suitable for entering the Global Healthcare Fraud Analytics Market?

Product Code: MRR-3E32260F81DD

1. Preface

1.1. Objectives of the Study
1.2. Market Segmentation & Coverage
1.3. Years Considered for the Study
1.4. Currency & Pricing
1.5. Language
1.6. Limitations
1.7. Assumptions
1.8. Stakeholders

2. Research Methodology

2.1. Define: Research Objective
2.2. Determine: Research Design
2.3. Prepare: Research Instrument
2.4. Collect: Data Source
2.5. Analyze: Data Interpretation
2.6. Formulate: Data Verification
2.7. Publish: Research Report
2.8. Repeat: Report Update

3. Executive Summary

4. Market Overview

4.1. Introduction
4.2. Healthcare Fraud Analytics Market, by Solution Type, 2022 vs 2030
4.3. Healthcare Fraud Analytics Market, by Delivery Model, 2022 vs 2030
4.4. Healthcare Fraud Analytics Market, by Application, 2022 vs 2030
4.5. Healthcare Fraud Analytics Market, by End-User, 2022 vs 2030
4.6. Healthcare Fraud Analytics Market, by Region, 2022 vs 2030

5. Market Insights

5.1. Market Dynamics
- 5.1.1. Drivers
  - 5.1.1.1. Increasing number of fraudulent activities in the healthcare sector
  - 5.1.1.2. Growing adoption of health insurance plans across the globe
  - 5.1.1.3. Rising need to track fraud & abuse efficiently in healthcare domain
- 5.1.2. Restraints
  - 5.1.2.1. High cost associated with healthcare fraud analytics services
- 5.1.3. Opportunities
  - 5.1.3.1. Introduction of healthcare BPO and fraud identity management software
  - 5.1.3.2. Integration of advanced analytics, artificial intelligence (AI) and, machine learning (ML) in healthcare fraud analytics software
- 5.1.4. Challenges
  - 5.1.4.1. Limitations pertaining to the use of healthcare fraud analytics software and services
5.2. Market Trends
5.3. Cumulative Impact of COVID-19
5.4. Cumulative Impact of Russia-Ukraine Conflict
5.5. Cumulative Impact of High Inflation
5.6. Porter's Five Forces Analysis
- 5.6.1. Threat of New Entrants
- 5.6.2. Threat of Substitutes
- 5.6.3. Bargaining Power of Customers
- 5.6.4. Bargaining Power of Suppliers
- 5.6.5. Industry Rivalry
5.7. Value Chain & Critical Path Analysis
5.8. Regulatory Framework
5.9. Client Customization

6. Healthcare Fraud Analytics Market, by Solution Type

6.1. Introduction
6.2. Descriptive Analytics
6.3. Predictive Analytics
6.4. Prescriptive Analytics

7. Healthcare Fraud Analytics Market, by Delivery Model

7.1. Introduction
7.2. On-Demand
7.3. On-Premise

8. Healthcare Fraud Analytics Market, by Application

8.1. Introduction
8.2. Insurance Claims Review
- 8.2.1. Post payment Review
- 8.2.2. Prepayment Review
8.3. Payment Integrity
8.4. Pharmacy Billing Misuse

9. Healthcare Fraud Analytics Market, by End-User

9.1. Introduction
9.2. Employers
9.3. Private Insurance Payers
9.4. Public & Government Agencies
9.5. Third-party service providers

10. Americas Healthcare Fraud Analytics Market

10.1. Introduction
10.2. Argentina
10.3. Brazil
10.4. Canada
10.5. Mexico
10.6. United States

11. Asia-Pacific Healthcare Fraud Analytics Market

11.1. Introduction
11.2. Australia
11.3. China
11.4. India
11.5. Indonesia
11.6. Japan
11.7. Malaysia
11.8. Philippines
11.9. Singapore
11.10. South Korea
11.11. Taiwan
11.12. Thailand
11.13. Vietnam

12. Europe, Middle East & Africa Healthcare Fraud Analytics Market

12.1. Introduction
12.2. Denmark
12.3. Egypt
12.4. Finland
12.5. France
12.6. Germany
12.7. Israel
12.8. Italy
12.9. Netherlands
12.10. Nigeria
12.11. Norway
12.12. Poland
12.13. Qatar
12.14. Russia
12.15. Saudi Arabia
12.16. South Africa
12.17. Spain
12.18. Sweden
12.19. Switzerland
12.20. Turkey
12.21. United Arab Emirates
12.22. United Kingdom

13. Competitive Landscape

13.1. FPNV Positioning Matrix
13.2. Market Share Analysis, By Key Player
13.3. Competitive Scenario Analysis, By Key Player
- 13.3.1. Merger & Acquisition
  - 13.3.1.1. ACKO Acquires Digital Health Platform Parentlane To Expand Beyond Core Insurance Offerings
  - 13.3.1.2. Amazon completes $3.9B acquisition of One Medical
- 13.3.2. Agreement, Collaboration, & Partnership
  - 13.3.2.1. Huize Announces Strategic Partnership with Ping An Health Insurance and the Joint Launch of "Chang Xiang An" - A Customized Long-term Medical Insurance Product
  - 13.3.2.2. Paul Merchants partners with Care Health Insurance
  - 13.3.2.3. Reliance General Insurance partners with Paytm to offer customisable health policy
- 13.3.3. New Product Launch & Enhancement
  - 13.3.3.1. SBI General Insurance launches new health insurance vertical
- 13.3.4. Investment & Funding
  - 13.3.4.1. Health insurance startup ClaimBuddy raises $3 million in funding
- 13.3.5. Award, Recognition, & Expansion
  - 13.3.5.1. Healthcos Are Accumulating Patents Aggressively In Electronic Records And Personalized Medicine
  - 13.3.5.2. AI-Powered Dental Insurance Fraud, Waste and Abuse Detection AI System

14. List of Company Mentioned

15. Appendix

15.1. Discussion Guide
15.2. License & Pricing